This month we will be taking a look at two topics that are not commonly discussed among adult ED clinicians and I expect the same is true for pediatric EM namely, compassionate and effective care of LGBTQ patients and the identification of patients with or at risk for non-accidental trauma (NAT). Recent articles in the New York Times and New Yorker (both attached) prompted interest in becoming better informed about gender identification. A lack of knowledge and cultural competency can create a major barrier to effective ED care. In fact, in one study (Bauer et al.) a majority of these patients reported negative ED experiences. There have also been questions raised (see JK Rowling) whether the “explosion” in gender dysphoric females reflects societal disparities or whether the decision-making process regarding reproductive altering hormonal or surgical interventions in gender dysphoric children can protect these individuals from having long-term regrets. I also wanted to draw your attention to an informative PBS Frontline piece: Growing up Trans

Among the host of risks from the Covid-19 epidemic, impairment and domestic abuse have increased worldwide as is reflected in a recent WHO report on child abuse and non-accidental trauma (NAT). With school closures and lockdowns, the safety nets that have helped with early identification of children at risk or who are victims of NAT have shrunk which may place a disproportionate role on the medical community. We will look at a recently published screening tool that may help identify those at risk. 

Janeway H, Coli CJ. Emergency care for transgender and gender-diverse children and adolescents. Pediatr Emerg Med Pract. 2020 Sep;17(9):1-20.

 House, H. et al., Sexual and Gender Minority Adolescents: Meeting the Needs of Our LGBTQ Patients and Their Families Clinical Pediatric Emergency medicine  Volume 20, Issue 1, March 2019, Pages 9-16

 Crumm CE, et al., Evaluation of an Emergency Department High-risk Bruising Screening Protocol. Pediatrics. 2021 Mar 2;147(4)